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Forever Blue 770 (PPO)

Our Forever Blue 770 (PPO) Medicare Advantage Plan is designed to make Medicare easy for you. If you travel often, you can enjoy the flexibility of BlueCard® network sharing. You'll pay the same as you would in-network for all plan-covered services outside of Northeastern New York participating areas. It is designed to give you the freedom to see any doctor or hospital that accepts Medicare nationwide.



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Forever Blue 770 (PPO)

This plan allows you to pay in-network copays with participating doctors or hospitals when you travel.

Your Estimated Monthly Premium $197.00


Primary Care Doctor Specialist
$10 $22
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Use our new Find a Doctor tool to discover if your doctor, specialist, or facility are in-network.

If they are not in-network, you can search to find one that is in our network of providers. 

Prescription Drugs

Drug Deductibles  $0 
Part D Prescriptions: Preferred Pharmacy Standard Pharmacy
Tier 1 $2 $7
Tier 2 $12 $17
Tier 3 $42 $47
Tier 4 $94 $100
Tier 5 33% 33%

The Medicare Part D Coverage Gap
The 'coverage gap' or 'donut hole' is a Part D drug coverage stage that changes what you pay for prescriptions. You may not end up in the coverage gap each year, but you should be aware of how it works. Our plans cover Tier 1 generics through the gap, so you would pay a copay for those drugs. 

The 2019 Medicare Formulary includes a list of prescription care drugs covered by a prescription drug plan.

Surgery and Treatment

Inpatient hospital $205/day, days 1-7; $1,435 max out-of-pocket per year
Outpatient hospital $250
Ambulatory surgery $175
X-rays $40
Advanced radiology $125
Laboratory services $5

Optional Supplemental Dental Care

Dental Coverage
Optional supplemental benefits (no network - see any dentist)

Premium Preventive Services (2 cleanings & 2 oral exams/year) Diagnostic and Restorative Service Cost Annual Max Allowance
Basic $19 50% coinsurance 50% coinsurance $500
Enhanced $38 Full coverage 50% coinsurance $1,000

Plan Highlights

Worldwide coverage for emergency and urgent care $90 Emergency care; $65 Urgent care
Part B diabetes supplies and monitors $0
Skilled nursing facility days 1-20 $0
Skilled nursing facility days 21-100 $172/day
Hearing aid (specific models)* $699 or $999/unit
In-network out-of-pocket maximum $5,500

*Our plans cover one routine hearing exam per year with a TruHearing® provider. Cost shares may apply. Please call TruHearing to verify your benefit and schedule a hearing exam. Hearing aid $699 or $999/unit (one per ear, per year, specific models). 

Combined in and out-of-network out-of-pocket maximum is $8,500. 

Plan Perks

What's Included: 

New! Up to $60 in Rewards:

Members get a $20 reward card (up to $60) each after receiving certain preventive services, including your annual wellness visit, colorectal cancer screening, and breast cancer screening (subject to medical necessity). 

Free Preventive Services: 

More than 20 services are included at no cost* when you use providers in our network. These services include annual wellness visit, bone density test, cardiovascular screenings, cancer screenings, diabetes self-management training, vaccines, and more. 

Free Gym Membership:

Stay active with access to more than 14,000 fitness locations nationwide with SilverSneakers®. Enjoy amenities including weight machines, cardio equipment, swimming pools, saunas, exercise classes for all fitness levels, and more. 

New! Telemedicine:

Medicare Advantage members now have access to Telemedicine, hosted by Doctor On Demand. Connect with a doctor 24/7 using your mobile device, tablet, or computer for only $5 more than your primary doctor cost-share.

$0 Care Management: 

Our nationally accredited care management team works with you and your doctor to help manage your health and meet your unique goals.

Care at HomeSM:

We've partnered with Landmark Health to create Care at Home℠ -- care and support available 24/7, provided in the comfort of your home. 

Contracts and Additional Resources

In order for services to be considered in-network while you're outside of the service area, the provider must participate with the local BlueCard® network sharing program in the service area and both you and the provider must be located in the same area when you receive care. Outside the U.S. you may be asked to pay 100% of the cost at the time of travel. You would then submit a claim to us to be reimbursed for your in-network cost-share.

Medicare Questions?

We're here to help.

1-833-735-4512 (TTY 711)
Oct. 1 - Dec. 31, 8 a.m. - 8 p.m., 7 days a week
Jan. 1 - Sept. 30, 8 a.m. - 8 p.m., Monday - Friday

*If you need a different format, please view our Multi-Language Interpreter Services.

BlueShield of Northeastern New York (BSNENY) is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. BSNENY is a division of HealthNow New York Inc., an independent licensee of the Blue Cross and Blue Shield Association. BSNENY complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-833-735-4515 (TTY 711). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-833-735-4515 (TTY 711).

Content last updated December 5, 2019.